Identifying trauma patients who benefit from whole blood transfusion: An effect decomposition analysis on patient...

Although whole blood (WB) transfusion has gained attention as a potentially superior alternative to component therapy (CT) for patients experiencing severe traumatic hemorrhage, conflicting evidence leaves its optimal use unclear.

We conducted a retrospective review of adult trauma patients treated at civilian trauma centers participating in Trauma Quality Improvement Program (TQIP) from 2020 to 2021. All received either WB or CT within four hours of emergency department arrival. We assessed the effect of WB versus CT by examining key clinical parameters and performing an effect decomposition analysis.

Of 34,476 patients, 9023 (29%) received WB, while 25,453 (71%) received CT alone. Across the entire cohort, there was no statistically significant difference in adjusted odds of 24-h mortality (aOR 0.85 [95% confidence interval (CI) 0.73-1.01], p = .052). However, patients presenting with hypotension showed lower unadjusted and adjusted odds of death when given WB, including those with systolic blood pressure (SBP) below 90 mmHg (aOR 0.72 [95% CI 0.55-0.96], p = .02) and 70 mmHg (aOR 0.64 [95% CI 0.45-0.91], p = .01).

These findings suggest that the effectiveness of whole blood (WB) is influenced by several clinical characteristics. Arrival hypotension appears to play a key role, accounting for 13% of the mortality difference observed with WB versus CT. Future prospective trials are needed to define optimal patient selection and identify those most likely to benefit from WB in trauma resuscitation.